turning fraud, waste, and abuse leads into turnkey allegations

Health plan special investigations units (SIUs) provide a valuable service in the fight against fraud, waste, and abuse (FWA). Unfortunately, an inordinate amount of plan resources are wasted vetting and investigating leads that often go nowhere.

Accordingly, payers are beginning to deploy their FWA resources more wisely and with greater impact through a new approach called “turnkey allegations.” A turnkey allegation is a ready-to-investigate case referral that has been vetted by an investigative team before the health plan SIU receives it.

Our latest white paper describes this fundamental shift in the way in which cases of fraud and abuse are identified and opened.

As detailed in the white paper, turnkey allegations require:

  • Analytics
  • Clinical, coding, and investigative expertise
  • Technology

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